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Navigating the Currents of Change: Transitioning to a New First Nations Health Governance Structure

Navigating the Currents of Change: Transitioning to a New First Nations Health Governance Structure

a publication of

Interim First Nations Health Authority 1205 - 100 Park Royal South West Vancouver, BC V7T 1A2 www.fnhc.ca | [email protected]

InterIm FIrst natIons HealtH autHorIty © 2012 Interim First Nations Health Authority All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.

Navigating the Currents of Change: Transitioning to a New First Nations Health Governance Structure iii

ContentsBackground & Introduction ............................................................. 1How Did We Get Here? ...................................................................... 1Consensus Paper 2012 Process and Purpose ....................................... 6

Navigating Change .......................................................................... 9Setting the Standards ........................................................................ 13Setting the Stages ............................................................................ 24Setting the Structure ........................................................................ 28

UPHOLDING OUR COMMITMENTS ............................................... 41Next Steps ....................................................................................... 46Summary of Consensus .................................................................... 53

APPENDIX: Resolution Adoption of Consensus Paper ........................ 61

1Background &Introduction

Navigating the Currents of Change: Transitioning to a New First Nations Health Governance Structure 1

Background & Introduction

How Did We Get Here?

Since 2005, First Nations in BC, and federal and provincial governments

have been committed to a shared agenda through the Transformative

Change Accord to establish a new relationship based on mutual respect

and recognition, and develop 10-year plans to bridge the differences

in socio-economic outcomes between First Nations and other British

Columbians particularly in the areas of: education, housing, economic

opportunities, and health.

In the area of health, progress has been made incrementally through

a series of political agreements between First Nations and federal and

provincial governments including the Transformative Change Accord:

First Nations Health Plan (2006), First Nations Health Plan Memorandum

of Understanding (2006), the Tripartite First Nations Health Plan (2007),

and the Basis for a Framework Agreement on First Nation Health

Governance (2010). First Nations have provided leadership and guidance

Section 1: Background & Introduction2

to these political agreements through annual Gathering Wisdom for a

Shared Journey forums.

At Gathering Wisdom for a Shared Journey IV in May 2011, First Nations

Chiefs and leaders, by a historic level of participation and consensus,

endorsed the Consensus Paper 2011: BC First Nations Perspectives on a

New Health Governance Arrangement and by doing so, charted a path

forward for the future of First Nations health governance. Through that

Consensus Paper 2011, First Nations:

Set the 7 Directives – the standards and requirements for how the •

new health governance structure must operate at the community,

regional and provincial levels

Directive 1 - Community Driven, Nation Based•

Directive 2 – Increase First Nations Decision-Making•

Directive 3 – Improve Services•

Directive 4 – Foster Meaningful Collaboration and Partnership•

Directive 5 – Develop Human and Economic Capacity•

Directive 6 – Be Without Prejudice to First Nations Interests•

Directive 7 – Function at a High Operational Standard•

Clearly established and reinforced the mandates and activities of:•

Regional Caucuses and Regional Tables: composed and •

representative of First Nations leaders and health professionals

in each region to serve as regional planning and engagement


forums about First Nations health programs and services,

and which will enter into arrangements with Regional Health

Authorities and the First Nations Health Authority. The FNHC

regional representatives were tasked with supporting the further

development of Regional Caucuses, and supporting Regional

Caucuses to develop Regional Tables.

The First Nations Health Council (FNHC): to provide political •

leadership and input to: support and assist First Nations in

achieving health objectives; health advocacy; research, policy

and program planning; the implementation of the bilateral and

tripartite health plans.

The First Nations Health Authority (FNHA): to undertake •

activities, from a First Nations perspective, in support of First

Nations health and wellness, including planning, designing,

managing, funding and delivering health programs to better

meet First Nations health needs in BC; building relationships with

the province and regional health authorities; leveraging additional

resources; undertaking research, collecting data and developing

policy and standards; and supporting First Nations regional

collaboration and dialogue.

The First Nations Health Directors Association (FNHDA): •

composed of Health Directors and managers working in First

Nations communities to: support education, knowledge transfer,

professional development and best practices for health directors


and managers; and, provide advice on research, policy, program

planning and design.

Endorsed the signing of the • Tripartite Framework Agreement on

First Nation Health Governance (“Framework Agreement”) – a legal

agreement establishing commitments for federal and provincial

governments and First Nations to work together to transfer the

operations of First Nations and Inuit Health Branch (FNIHB)-BC region

to a First Nations Health Authority, and to provide a greater role for

First Nations in the broader health system in Canada and BC with

respect to First Nations health needs. First Nations also directed the

FNHC to engage with federal and provincial governments to prepare

the implementation plan, and strike the tripartite implementation

committee for the Framework Agreement.

Directed the FNHC to engage with federal and provincial •

governments to finalize the Health Partnership Accord.

Directed the FNHC to provide political leadership to develop models •

and options for an FNHA, and directed that the First Nations Health

Society be transitioned to the interim FNHA and begin the early steps

in implementing the new health governance arrangement.

Directed the FNHC to continue to engage and share information •

with, and be accountable to, First Nations through a variety of

mechanisms, including Regional Caucuses presentations, annual

reports, communiqués, online and digital media, and Gathering


Wisdom for a Shared Journey forums (including holding Gathering

Wisdom for a Shared Journey V in May 2012 to report on progress

and seek further direction and approvals of First Nations Chiefs in

BC).

Since Gathering Wisdom IV in May 2011, work has been proceeding

as per the direction of BC First Nations outlined above. In the fall of

2011, the Resolution 2011-01 Workplan was released, detailing the

milestones, key decision points, and timeframes for the implementation

of the direction provided by BC First Nations, as well as an Engagement

& Approval Pathway to ensure BC First Nations are involved in strategic-

level decisions made in the First Nations health governance process. The

First Nations Health Society has been transitioned to the interim FNHA.

Processes for the implementation of the Framework Agreement have

been developed, shared and put into practice. First Nations have been

working as Regions to develop Terms of Reference, relationships with

Regional Health Authorities, and Regional Tables.

Over the past year, significant progress has been made, informed by

regular guidance from BC First Nations Chiefs and leaders at Regional

and Sub-Regional Caucus throughout the province. Regular reports on

progress, as directed by the Consensus Paper 2011: BC First Nations

Perspectives on a New Health Governance Arrangement, have been

made at Regional and Sub-Regional Caucus sessions, other community

meetings, through ongoing communications mechanisms, and through

the Navigating the Currents of Change: Transitioning to a New First

Nations Health Governance Structure Workbook (2012).


CONSENSUS PAPER 2012 PROCESS AND PURPOSE

Over the past four years, more than 150 Regional and Sub-Regional

Caucus, and other community meetings have taken place to inform the

work of the FNHC, FNHDA, and interim FNHA; through these meetings,

First Nations Chiefs, leaders and senior health leads provide, their

wisdom, direction, innovation, thoughts and perspectives on the work

moving forward.

ProcessAs per the Resolution 2011-01 Workplan Engagement & Approvals

Pathway, in January 2012, the FNHC launched a Navigating the Currents

of Change: Transitioning to a New First Nations Health Governance

Structure Workbook, and made the Workbook the focus of a series

of First Nations regional caucus sessions across the province. The

Workbook took into account the feedback and direction of First Nations

through the more than 150 meetings held to date. Feedback from

the Workbook was developed into a series of five regional summary

documents, which were then merged into this province-wide Consensus


Paper 2012: Navigating the Currents of Change – Transitioning to a New

First Nations Health Governance Structure.

PurposeThis Consensus Paper 2012 is now being put forward for review and

consideration for ratification at the 5th Annual Gathering Wisdom for a

Shared Journey Forum to be held on May 15-17, 2012. Its purpose is to

chart a course for the effective management of change and transition

to a new First Nations health governance structure in BC and the

achievement of the vision of healthy, self-determining and vibrant BC

First Nations children, families, and communities. It collates all of the

feedback and direction provided by First Nations for the transition to the

new First Nations health governance arrangement and in particular:

Describes the strategy of BC First Nations for navigating change over •

the next several years, through: Setting Standards; Setting Stages;

and, Setting Structure;

Reaffirms and strengthens the process for ongoing engagement, •

transparency, and reciprocal accountability; and,

Sets out a clear set of next steps in transitioning to the new health •

governance structure.

2Navigating Change


Navigating Change

What Is Change?

Change is a process of becoming different. The decision by First Nations

leaders in May 2011 to approve Resolution 2011-01, the Consensus

Paper 2011: BC First Nations Perspectives on a New Health Governance

Arrangement and the Tripartite Framework Agreement on First Nation

Health Governance triggered a transformative change process that will

take many years. The journey of change can be challenging, but change

processes can be managed through leadership and planning – by

influencing, facilitating and managing change, we do not allow change

to manage us.

Navigating Change – Lessons Learned

First Nations are best positioned to manage this change since we know

what our communities need. At the same time, we have learned lessons

in how to best manage this change from our Indigenous brothers and

Section 2: Navigating Change10

sisters at home and abroad that have navigated these currents before

us:

Ensure consistent, committed and long-term leadership, intention, •

and vision

Separate and respect political and business/operational roles•

Undertake a disciplined approach to the work focusing on reciprocal •

accountability and long-term sustainability

Have committed partners to support the work as it moves forward•

Build upon a foundation of legislative authority as developed by First •

Nations

Ensure a good and timely flow of information and provide •

opportunities for input, discussion and feedback – communities must

understand the process, like the process, and trust the process and

its leadership

Focus on value for investment and efficiency in spending, including •

through encouraging collaborations and economies of scale for

service delivery; this sometimes includes making tough decisions for

the greater good


Understand that significant change requires shifts in attitude, •

behaviour, and mindset

Be flexible in order to take advantage of new opportunities, or •

address unexpected issues as they arise

Over the past several years, First Nations have followed many of

these teachings – we have been committed to building an effective

working partnership with federal and provincial governments, we have

established structures for ongoing communications and engagement,

and we have been working on the separation of political and business/

operational roles, among many other things.

Navigating Change – BC First Nations Approach

Through the Navigating the Currents of Change Workbook process,

we have focused on how we will continue to manage change for the

next phase of the work, in accordance with the above teachings and

building upon the work that BC First Nations have completed to date.

Specifically, First Nations will reflect the above teachings and effectively

navigate change by:

SETTING THE STANDARDS •

Directives, Governance Standards, Competencies•

SETTING THE STAGES •


Planning for Transition and Transformation•

SETTING THE STRUCTURE•

Determining the Board structure of the FNHA, the overall model •

for the new First Nations Health Governance Structure, and the

concept of Regional Offices


SETTING THE STANDARDS

A key way to manage the journey of change is through consistent

and long-term leadership and intention, and by undertaking a

disciplined approach to the work. Leaders achieve this through

establishing standards – strategic-level expectations of quality or

achievement. BC First Nations have done significant work to date in

setting standards (7 Directives and Framework Agreement Corporate

Governance Requirements) for the new First Nations health governance

structure, and through the latest Navigating the Currents of Change

Workbook, have established new standards for the work moving

forward (Competencies). These standards will guide all of our work

moving forward. Establishing these strategic-level standards equips

us with the expectations of our leadership for the new First Nations

health governance structure and process, and serve as a checklist of

requirements that guide our decision-making and help us measure our

progress and outcomes.


Directives

In May 2011, through the Consensus Paper 2011: BC First Nations

Perspectives on a New Health Governance Arrangement, First Nations

established 7 Directives and thereby set the fundamental standards for

the new First Nations health governance structure and process:

DIRECTIVE #1: COMMUNITY-DRIVEN, NATION-BASED•

The community-driven, nation-based principle is overarching and •

foundational to the entire health governance arrangement

Program, service and policy development must be informed and •

driven by the grassroots level

First Nations community health agreements and programs must •

be protected and enhanced

Autonomy and authority of First Nations will not be compromised•

DIRECTIVE #2: INCREASE FIRST NATIONS DECISION-MAKING •AND CONTROL

Increase First Nations influence in health program and service •

philosophy, design and delivery

Develop a wellness approach to health including prioritizing •

health promotion and disease and injury prevention


Implement greater local control over community-level health •

services

Involve First Nations in federal and provincial decision-making •

about First Nations health at the highest levels

Increase community-level flexibility in spending decisions to meet •

their own needs and priorities

Implement the OCAP (ownership, control, access and possession) •

principle regarding First Nations health data, including leading

First Nations health reporting

Recognize the authority of individual BC First Nations in their •

governance of health services in their communities and devolve

the delivery of programs to local and regional levels as much as

possible and when appropriate and feasible

DIRECTIVE #3: IMPROVE SERVICES•

Protect, incorporate and promote First Nations knowledge, •

beliefs, values, practices, medicines and models of health and

healing into all health programs and services that serve BC First

Nations

Improve and revitalize the Non-Insured Benefits program•


Increase access to primary care, physicians, nurses, dental care •

and other allied health care by First Nations communities

Support health and wellness planning and the development of •

health program and service delivery models at local and regional

levels

DIRECTIVE #4: FOSTER MEANINGFUL COLLABORATION AND •PARTNERSHIP

Collaborate with other First Nations and non-First Nations •

organization and governments to address social and

environmental determinants of First Nations health (e.g. poverty,

water quality, housing, etc.)

Foster collaboration in research and reporting at all levels•

Support community engagement hubs•

Enable relationship-building between First Nations and the •

Regional Health Authorities and the First Nations Health

Authority with the goal of aligning health care with First Nations

priorities and community health plans where applicable


DIRECTIVE #5: DEVELOP HUMAN AND ECONOMIC CAPACITY •

Develop current and future health professionals at all levels •

through a variety of education and training methods and

opportunities

Result in opportunities to leverage additional funding and •

investment and services from federal and provincial sources for

First Nations in BC

Result in economic opportunities to generate additional resources •

for First Nations health programs

DIRECTIVE #6: BE WITHOUT PREJUDICE TO FIRST NATIONS •INTERESTS

Not impact on Aboriginal Title and Rights or the treaty rights of •

First Nations, and be without prejudice to any self-government

agreements or court proceedings

Not impact on the fiduciary duty of the Crown•

Not impact on existing federal funding agreement with individual •

First Nations, unless First Nations want the agreements to change


DIRECTIVE #7: FUNCTION AT A HIGH OPERATIONAL STANDARD•

Be accountable, including through clear, regular and transparent •

reporting

Make best and prudent use of available resources•

Implement appropriate competencies for key roles and •

responsibilities at all levels

Operate with clear governance documents, policies, and •

procedures, including for conflict of interest and dispute

resolution

Corporate Governance Requirements

By adopting the May 2011 Consensus Paper 2011: BC First Nations

Perspectives on a New Health Governance Arrangement, BC First

Nations also adopted the Tripartite Framework Agreement on First

Nation Health Governance, including a set of corporate governance

requirements for the First Nations Health Authority:

FNHA Corporate organization and separation of functionsThe FNHA shall have at least the following corporate and organizational

elements and characteristics:


The membership structure shall be representative of and approved (a)

by BC First Nations;

The board of directors shall reflect a broad range of skills and (b)

experience to enable it to act effectively to fulfill the mandate of

the FNHA and shall be chosen by the members pursuant to a formal

and transparent nomination and or selection process;

FNHC members may not sit on the FNHA board of directors, though (c)

they may be members of the FNHA;

It shall be a condition of directorship on FNHA’s board (and as (d)

part of the code of conduct of such board), that FNHA directors

must act independently and solely in the best interests of FNHA,

and that no director may serve the interests of his or her affiliated

groups, including, without limitation, the FNHC, unless, in doing

so, such director is also acting in the best interests of FNHA and the

fulfilment of its mandate on behalf of First Nations in BC;

There shall be public disclosure of directors’ per diem allowances, (e)

travel expenses and any other remuneration;

Its employees shall be chosen pursuant to a selection process (f)

targeting most qualified candidates, and shall be paid reasonable

remuneration that is reflective of experience, position and duties

fulfilled;


There shall be a clear separation of functions and roles. No one (g)

person may simultaneously act as more than one of (i) member (ii)

director and (iii) employee; and

The following persons may not serve as directors of the FNHA:(h)

Elected federal, provincial or municipal officials; and•

First Nations health directors. •

Planning/Performance/EvaluationThe FNHA shall operate according to the following characteristics (a)

and principles regarding its planning, performance and evaluation

processes:

The directors shall act on a fully informed basis, in good faith, with (b)

due diligence and care, and in the best interest of the organization

and its members and stakeholders;

The directors shall approve corporate and operational plans and (c)

strategic vision;

Organizational and operational (health) performance goals shall be (d)

set and updated; and


There will be an objective evaluation of performance of the (e)

directors and monitoring the effectiveness of the FNHA’s

governance practices.

Budgets / strong financial control / monitoring and audit systemsThe FNHA shall have strong internal controls systems, budgeting and

allocation processes including as set out in section 4.2(2) (k) (l) and (m)

of the main body of this Agreement.

Conflicts of interest / ethics The FNHA shall have strong internal conflict of interest and ethical

standards, with the following minimums:

a written code of conduct for board of directors and employees (a)

(ethics);

a written conflict of interest policy and procedures that ensure that (b)

a director does not vote and an employee does not make a decision

on a matter in which they have a personal interest; and

policies and mechanisms to monitor compliance.(c)

Accountability and reporting The FNHA shall have strong internal accountability processes, with the

following minimums:

the directors shall be accountable to members; and(a)


all members shall be provided with timely access to relevant (a)

information, and, upon request, copies of financial reports, audit

findings and a copy of the Canada Funding Agreement.

Competencies

Through the Navigating the Currents of Change Workbook, First Nations

reviewed, commented on, and improved a set of competency standards

for the Board members of the FNHA:

Have no conflict of interest or legal impediment that would interfere •

with the exercise of the Director’s independent judgment (including

that one cannot be a Chief or Councillor, an FNHC member, an

FNHDA member, a health director, or an elected federal, provincial,

or municipal official)

BC First Nations individuals highly preferred, and regardless, a high •

degree of cultural competency and knowledge of BC First Nations

communities (including rural, remote, urban, and other issues facing

First Nations)

Qualities of intelligence, strategic thinking, perceptiveness, good •

judgment and common sense, maturity, ethics, integrity, and fairness

Time, energy, interest and willingness to serve as a Director of the •

FNHA, including a commitment to learning and an appreciation of

the significance of the work


Prior Board experience with a positive record of accomplishment, •

including solid understanding of Board legal and fiduciary

responsibilities

Knowledge of, and experience with, First Nations, federal, and •

provincial health systems, programs and services

Extensive and proven experience in successfully running a large •

operation or working at a senior management level and managing

organizational change and development

Experience in tripartite processes, building and maintaining •

successful partnerships with governments and others organizations,

and managing competing priorities amongst diverse partners and

stakeholders

Experience in strategic planning, health planning, financial planning, •

and community development

Desirable qualifications include CA or similar designation, MBA or •

comparable university degree, degree of a designated health care

professional (or equivalent experience)

Board members should reflect healthy living – emotionally, physically, •

spiritually, mentally

The Board as a whole shall reflect a broad range of skills and •

experience


SETTING THE STAGES

The journey of change can be managed through planning. Planning

is using whatever facts we have to make our best predictions about

the future and choose the best steps to accomplish our goals, spend

resources wisely, and avoid any unnecessary mistakes. It:

Helps us to think ahead and prepare for the future •

Pinpoints problems and issues and helps us find solutions•

Helps us do “first things first”•

Helps us coordinate projects/steps/tasks with one another•

Helps us communicate, educate, and inform ourselves, our •

communities, our partners

Helps us make best use of available resources•


To allow us to manage change carefully and responsibly, First Nations

have established stages for the First Nations health governance structure

and process moving forward – transition and transformation.

We are currently in the transition stage of the work. During this stage,

we implement the Framework Agreement, with particular focus on

the activities to take control of the assets, people and resources of the

FNIHB, BC Region, adjust to that transfer of FNIHB, and develop and

implement the health governance structure that suits our needs. Most of

this work will be completed over the next two years:

The interim FNHA builds and implements capacity to receive •

transfer (2011-2013) and continues organizational development

(2013-ongoing)

The interim FNHA is transitioned to the permanent FNHA (upon •

First Nations approval of Board structure of the FNHA at Gathering

Wisdom for a Shared Journey V)

The sub-agreements are finalized and implemented (target: October •

2013)

The Medical Service Plan (MSP) Premiums Letter of Understanding •

and Health Partnership Accord are finalized (target: 2012)

The Interim Management Committee is disbanded (target: October •

1, 2013)


The Transition Team is disbanded (target: October 13, 2013)•

The 5-year implementation plan has been executed and •

Implementation Committee has been disbanded (October 13, 2016)

Once the majority of the tasks in the transition stages have been

completed – and particularly the date of the transfer of FNIHB to

the FNHA takes place, we will then enter into the ongoing period of

transformation, where we as BC First Nations will take the existing

federal programs and services and upgrade and re-orient them to meet

our needs. Some of these activities overlap with the transition stage –

the transition and transformation phases overlap:

First Nations set priorities for program and service redesign (2013/14)•

Program and service redesign, innovation and evaluation (Ongoing)•

Implementation and evolution of health partnership (Ongoing)•

Work of the FNHC, FNHA, and FNHDA (Ongoing)•

Work of the Regions, supported by Regional Offices (Ongoing)•

Community engagement and Gathering Wisdom for a Shared •

Journey Forums (Ongoing)


Evaluation of the performance of the First Nations health governance •

structure (Ongoing)

These strategic-level planning stages will guide our efforts moving

forward. Establishing these stages equips us with the framework for

more detailed planning, ensuring that we undertake activities at the

appropriate time, make best use of available resources, and manage

change in an orderly and transparent way. It also ensures that BC First

Nations are engaged and involved in setting strategic direction for each

phase of the work.

Figure 1. The strategic-level Planning Stages: Transition and Transformation

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SETTING THE STRUCTURE

At Gathering Wisdom for a Shared Journey IV, First Nations clearly

established and reinforced the mandates and activities of Regional

Caucuses and Regional Tables; the FNHC; the FNHDA; and the FNHA

and described expectations for how these various elements of the

structure work together.

Figure 2. The Elements confirmed by First Nations leaders for the new First

Nations Health Governance Structure

FIRST NATIONS COMMUNITIES

COMMUNITY ENGAGEMENT

REGIONAL OFFICES

SUB-REGIONAL CAUCUSES

REGIONAL TABLES

REGIONAL CAUCUSES

SEPARATION OF BUSINESS & POLITICS

RL

RL

RLRL

RL

MEMBERS OF THE FIRST NATIONS HEALTH AUTHORITYFIRST NATIONS

HEALTH DIRECTORS ASSOCIATION

FIRST NATIONS HEALTH AUTHORITY STAFF

DIRECTORS OF THE FIRST NATIONS HEALTH AUTHORITY

FIRST NATIONS HEALTH COUNCIL

Advice

Advice

SEPARATION OF BUSINESS & POLITICS


First Nations Health Authority Board Structure

At Gathering Wisdom for a Shared Journey IV, First Nations directed

the FNHC to develop models and options for the FNHA. Through the

Navigating the Currents of Change Workbook process, the FNHC

shared models and options with First Nations and First Nations have

determined:

that the Board of Directors of the FNHA will be regionally-•

representative

that staggered terms must be put into place to ensure smooth •

transitions, appropriate orientation, continuity, and corporate

memory

that a rigorous orientation process for new Board members is •

required, to ensure they are culturally-competent and fully familiar

with their legal and fiduciary obligations as Board members

that mentorship materials be developed to generate awareness of •

Board responsibilities, and increase the capacity of BC First Nations to

participate on the Board of the FNHA

that an Elder advisor position for the Board of the FNHA should be •

established to provide traditional wisdom and guidance to the Board

First Nations were also clear that the while the regionally-representative

model will ensure that the Board will reflect the needs and realities of


First Nations in BC, we must take good care to manage Board costs

(Board processes must be cost-effective), keep politics out of the

process, and avoid conflict of interest. Essentially, we must ensure that

all Board members work on behalf of all BC First Nations.

The following process for addressing local and regional issues will ensure

that the Board may be regionally-representative, while maintaining its

obligation to make decisions of benefit to all BC First Nations:

Figure 3. Addressing Regional Issues in the health governance structure.

1. First Nation(s) identi�es

issue

2. First Nation raises

issue at Regional Caucus

3. FNHC regional

rep(s) raise issue with

FNHC

4. FNHC discusses and

develops strategic position

5. FNHC provides strategic

position to FNHA Board

6. FNHA Board takes

business/ operational decision to

address issue

Addressing Regional Issues

in the Health Governance

Structure


Through the Navigating the Currents of Change Workbook process, First

Nations have stated that there must be a clear, consistent, cost-effective,

and planned process for Board posting, nomination, and selection,

including sufficient time for First Nations to fully participate in the Board

nomination process and increase awareness and capacity amongst BC

First Nations to meet this unique opportunity. A strategy and tools will

support the implementation of the following process for the FNHC

Board of Directors selection process:

FNHA Board of Directors: Regional Representation9-member Board of Directors•

1 Board member chosen from each of the five regions: Fraser; •

Interior; North; Vancouver Coastal; and, Vancouver Island

4 additional Board members chosen at-large in order to ensure •

that the Board reflects all competencies and a diversity in skills

and experience

Staggered terms between the regionally-representative Board •

members and the at-large Board members to ensure continuity

and corporate memory and the opportunity for mentorship

Nomination process for Regional Representation:•

Each Regional Caucus undertakes an open and transparent •

application process


Each Regional Caucus, through their Regional Table, receives •

applications for interested potential Board members from their

Region, and screens those applications against the competencies

on page 10

Regional Caucus nominates qualified potential Board members •

FNHA Members then review all nominations from Regional •

Caucuses and selects one Board member per region to ensure

that a good mix of expertise, experience, and competencies are

represented on the Board

Process for 4 Board members chosen at-large:•

FNHA Members undertake an open and transparent application •

process, and also consider the nominations provided by Regional

Caucuses in the Nomination Process for Regional Representation

FNHA Members then review all applications and nominations •

from Regional Caucuses against the expertise, experience and

competencies of the 5 regionally-representative Board Members,

and selects 4 Board members at large to ensure that the Board as a

whole reflects a broad range of skills and experience


Figure 4. The Model. This map shows how the new First Nations Health

Governance Structure operates from the community, to the regional, to

the provincial level.

RL

RL

RL

RL

RL

FNHA Head Office

FNHA Northern Office

FNHA Interior Office

FNHA Fraser Office

FNHA Vancouver Island Office

FNHA Vancouver Coastal Office

First Nations Health Council

First Nations Health Directors Association

+ TBD

Interim and Permanent FNHA BoD

RLRegional Director

Regional Liaisons

Regional Caucuses

Community Engagement

Regional Tables

Communities


First Nations Health Governance Model – A Holistic Approach

At Gathering Wisdom for a Shared Journey IV, First Nations directed

the FNHC to develop models for the First Nations health governance

structure and provide those models to First Nations for review,

discussion, and approval. Through the Navigating the Currents of

Change Workbook process, First Nations reviewed four different types

of models – a non-profit model, a corporate model, a legislative model,

and a hybrid model – and have indicated a strong preference for a

holistic model:

our health governance model must embody First Nations •

philosophies, holistic approaches to health and wellness (including

medicine wheel), and reflect the importance of community

engagement

our health governance model must blend the best of available •

non-profit, corporate, and legislative models, while separating and

respecting political/governance and business/operational roles

we must take advantage of and create opportunities to amend •

existing legislation to better meet our needs, and develop new

legislation to recognize the unique holistic First Nations health

governance model – but all approaches to legislation must be

carefully considered and planned


legislation must be the foundation of, and clearly describe the •

new First Nations health governance structure, particularly how it

is accountable to First Nations; any other non-profit and corporate

entities would flow underneath that legislation and be subject to

transparency and accountability rules established in the legislation

(including publishing financial and annual reports for review by BC

First Nations)

any corporate and business models we pursue must: result in •

improved services to First Nations; result in improved access to

services by First Nations; provide returns that are reinvested in the

First Nations health system to support ongoing sustainability and

improvement of services; and, be consistent with First Nations values

and the 7 Directives

the model must meet the 7 Directives and be consistent with •

applicable legislation

Planning for a holistic First Nations health governance model will

proceed on the basis of the direction provided by BC First Nations above,

and must be informed by further research, with particular focus on:

other examples of First Nations health governance models in Alaska, •

Bigstone, and other jurisdictions, including best practices and lessons

learned


profiling Regional Health Authorities – their structure and how they •

work

the concepts of an Ombudsperson and a Charter of Rights for First •

Nations Health

a legal analysis of existing legislation and a strategy for achieving •

legislative change to benefit BC First Nations, and a legal analysis of

legislation to create the new holistic First Nations health governance

structure

business plans and an analysis of the sustainability of the First •

Nations health governance structure

an overall map of how the holistic First Nations health governance •

structure will work

This research on a holistic First Nations health governance model will be

provided to BC First Nations for further discussion, development, and

strategic decisions.

Regional Offices

At Gathering Wisdom for a Shared Journey IV, First Nations Chiefs

directed the First Nations Health Council to support Regional Caucuses

to further develop their own structures and processes, engage in

relationship development with Regional Health Authorities, and develop


Regional Tables. With the signing of the Framework Agreement on

October 13, 2011, the milestones of – and opportunities for – the

Regions has increased further. The workload of regions includes:

Engagement with First Nations – collaboration, unity, •

communication, relationship-building, “make room for everyone”

Receive reports from, provide direction to, and appoint, •

representatives to the First Nations Health Council and to the

Regional Table

Provide guidance to the work of the First Nations Health Authority •

and First Nations Health Directors Association

Develop and implement agreements with Regional Health Authorities •

to improve regional health and wellness services to First Nations

Develop Regional Health and Wellness Plans and identify regional •

health initiatives

Establish Terms of Reference (including determining terms for their •

representatives to the FNHC) and processes for effective, efficient,

and sustainable operations

A consistent theme and concept raised by First Nations in the over 150

Regional and Sub-Regional Caucus sessions and other meetings is that

there is a need for greater technical capacity to undertake this work,


and for a central hub and repository for information relating to the work

of the FNHC, FNHDA, FNHA, and the Regions, and First Nations health

and wellness issues. Through the Navigating the Currents of Change

Workbook process, First Nations support the establishment of Regional

Offices that will:

support all regional efforts in communication, collaboration, and •

planning, including supporting the political (FNHC) conversation

within the region, the service (FNHA) conversation within the region,

and the technical/professional development (FNHDA) conversation

within the region

coordinate the alignment of and communication across Regional •

Caucuses, sub-Regional Caucuses, Regional Tables, and First Nations

provide technical support to the work of the Regional Caucus •

and Regional Table, including undertaking technical work such as

research, analysis, writing

facilitate the involvement of Regional Health Authorities and other •

regional partners in the regional First Nation health processes, plans,

and priorities

conduct outreach and communications with First Nations throughout •

the region


provide technical leadership to the development of Regional Health •

& Wellness Plans

provide technical support for communicating regional First Nations •

issues, priorities, successes

serve as the central repository and main contact for information and •

community engagement within the region

draw or build upon the offices and assets that will be transferred •

from FNIHB-BC Region to the FNHA, and the offices and assets of

the Regional Health Authorities

contribute to the overall cost-effectiveness of regional community •

engagement and technical support (so that funding is prioritized for

health programs and services)

eventually evolve into facilitating service delivery at the regional level•

To meet the above outcomes, First Nations have suggested that the

establishment of Regional Offices must be carefully planned, and that

piloting Regional Offices may be a prudent approach.

3UpholdingOurCommitments


UPHOLDING OUR COMMITMENTS

A high standard of engagement, accountability, and transparency has

been set in the First Nations health governance process, and is the

foundation for our success.

Reciprocal Accountability

At Gathering Wisdom for a Shared Journey IV in May 2011, First Nations

set a clear definition and principles for Reciprocal Accountability. It

means shared responsibility – amongst First Nations (at community,

regional and provincial levels), the Federal Government, and the

Provincial Government (including Health Authorities) – to achieve

common goals. Each entity involved in the partnership and relationship

must be responsible for their commitments, and for the effective

operation of their particular part of the system, recognizing that each

part is interdependent and interconnected.

Section 3: Upholding Our Commitments42

Processes for Reciprocal Accountability (Consensus Paper 2011)

Co

mm

un

ity

Leve

l

Political leaders to collaborate with their health technicians •

First Nations individuals and communities supporting their •

own health and well-being, and understanding how their

actions impact First Nations health programs and services for

all First Nations in BC

First Nations political and technical leaders actively •

contributing to the implementation of the Health Plans

including by participating in their Regional Caucus

Accountability of First Nations political and technical leaders •

to their respective communities for funding, services,

professional standards, cultural teachings, best practices and

ethics and cost-efficiency


Reg

ion

al L

evel Regional Caucus sessions to report on progress, share •

information, and develop common positions and perspectives

for the Regional Table to advance

Establishment of Regional Tables to advance a united, •

effective, and sustainable approach for the region

Regional collaborations, partnerships and agreements •

between Regional Tables with Regional Health Authorities

and the FNHA to share responsibility and decision-making for

health services to First Nations

Pro

vin

cial

/ N

atio

nal

Lev

el

Regular meetings of the Tripartite Committee on First Nations •

Health to measure progress of the Health Plans and discuss

potential changes to roles, powers or funding that may be

required

Regular senior political and technical meetings with key •

decision-makers at national and provincial levels to focus on

BC First Nations health priorities and plans

Effective, respectful, and sustainable working partnerships •

between the FNHC, FNHDA, and FNHA for the benefit of

First Nations health and wellness in BC


Engagement

Community engagement – communications, collaboration, and planning

– is a cornerstone of the First Nations health governance structure.

Resolution 2011-01 passed by First Nations at Gathering Wisdom for

a Shared Journey IV called upon the FNHC to develop a Workplan,

including how First Nations will continue to be involved in and provide

guidance to the process. Therefore, a key component of that Resolution

2011-01 Workplan was the Engagement & Approval Pathway, which

describes a consistent process for First Nations to provide direction for

the work moving forward.

Engagement

Discussion Document

Engagement Summary

Building Consensus

Ratification

Reciprocal Accountability

7 Directives

Engagement & Approval

Pathway

Based on the engagement, developing options, questions, and models and providing those back to First Nations in BC for further engagement.

Based on the discussion document engagement, providing a description of the common area(s) of agreement amongst BC First Nations as it relates to that health and wellness matter.

A process of dialogue, and amendment as required, to amend the Engagement Summary to build and capture consensus amongst First Nations in BC.

A process of approval for the Consensus reached amongst First Nations in BC.

A process of collecting wisdom, advice, feedback, and guidance from First Nations in BC on a health and wellness matter.


The engagement process of the FNHC, FNHDA and FNHA (including the

interim FNHA) will utilize this Engagement & Approval Pathway, and

employ it to obtain First Nations feedback and direction on strategic-

level decisions with respect to the First Nations health governance

structures – these are decisions that concern leadership-level direction,

long-term goals, philosophies and values; they are decisions of

significant importance and reach far into the future.

In addition to the engagement on strategic decisions conducted through

the Engagement & Approval Pathway, regular engagement, two-way

reporting, and communications take place, and will continue to take

place, at various forums and through a variety of media, including:

Regional and Sub-Regional Caucus meetings•

Gathering Wisdom for a Shared Journey forums•

Annual reports•

Quarterly infobulletins•

Monthly FNHC meeting summary letters•

Website, videoconferences, and social media•

Articles•

Through the Navigating the Currents of Change Workbook process,

First Nations emphasized the ongoing importance of this level of

engagement, and stressed the role of Regional Offices in improving

the process by serving as the central contact for questions and

communications needs of the Regions. First Nations have also expressed

the need for greater consistency and focus to engagement by defining

priorities, milestones, and schedules.


Next Steps

By adopting this Consensus Paper 2012: Navigating the Currents of

Change – Transitioning to a New First Nations Health Governance

Structure, BC First Nations chart their path for navigating the currents

of change in transitioning to the new First Nations health governance

structure.

In May 2011, First Nations set standards and requirements for how

the new health governance structure must operate at the community,

regional and provincial levels. First Nations also clearly established and

reinforced the mandates and activities of the FNHC, FNHDA and FNHA.

Now, in May 2012, First Nations reaffirm the standards and

requirements for the new health governance structure, and establish

new standards (competencies) for the leadership of one of the key

components of the structure – the FNHA. First Nations affirm the

planning stages and key activities within each planning stage. First

Nations create a new Board structure for the FNHA, and a process for

the selection of that Board. First Nations agree to an overall model


for the First Nations Health Governance structure that is a holistic one

– one that takes the best of all available non-profit, corporate, and

legislative tools and blends those tools with First Nations teachings to

create a model that suits First Nations. First Nations also support a key

mechanism for ongoing communications, engagement, and improved

service to First Nations communities – Regional Offices.

The next steps to this Consensus Paper 2012: Navigating the Currents

of Change – Transitioning to a New First Nations Health Governance

Structure are as follows. These next steps must be implemented in a

manner consistent with the Standards and Planning Stages outlined in

this Consensus Paper 2012 and the content of the Consensus Paper

2011.

Consensus Paper 2011: BC First Nations Perspectives on a New Health Governance Arrangement

The Consensus Paper 2011 continues to provide guidance and •

direction to the implementation of the new First Nations health

governance arrangement

The FNHC will continue to implement the next steps outlined in •

the Consensus Paper 2011: BC First Nations Perspectives on a New

Health Governance Arrangement


First Nations Health Authority

First Nations have agreed that the structure of the Board for the •

FNHA must be a regionally-representative model:

The iFNHA Members will amend the bylaws of the interim FNHA •

to implement a regionally-representative structure, increase the

size of the Board from 7 to 9, and transition the interim FNHA to

the FNHA

By April 2013, the FNHC will work with legal counsel to develop •

a consistent, cost-effective, and transparent process to support

all Regions to undertake Board posting, recruitment, assessment,

and nomination processes for 5 regionally-representative Board

positions

By April 2013, the FNHC will develop mentorship materials to •

generate awareness of Board responsibilities, and increase the

capacity of BC First Nations to participate on the Board of the

FNHA

From April 2013 to October 2013, the FNHC regional •

representatives will work with their respective Regions to

implement this process of posting, recruitment, and assessment,

resulting in regional Board nominations by November 2013

The Members of the iFNHA will appoint the 5 regionally-•

representative Board members by March 2014, ensuring that an


appropriate mix of expertise, experience, and competencies are

represented on the Board

The Members of the iFNHA will implement staggered terms, and •

therefore retain 4 existing iFNHA Board members in at at-large

capacity until 2015 (a recruitment process for 4 at-large Board

positions will take place in 2014)

The FNHC will develop a rigorous orientation process for Board •

members, to ensure that all Board members are culturally-competent

and fully familiar with their legal and fiduciary obligations

The FNHC will work with the iFNHA to develop and implement a •

cost-effective plan and process for an Elder advisor for the Board of

Directors of the iFNHA (and FNHA)

First Nations Health Governance Structure Model

The First Nations health governance structure model will be a holistic •

one that embodies First Nations philosophies and holistic approaches

and blends this with the best of available non-profit, corporate, and

legislative models

Planning for a holistic First Nations health governance model will •

be informed by further research to be conducted by the FNHC

and iFNHA and provided to BC First Nations for further discussion,

development, and strategic decision, including:


other examples of First Nations health governance models in •

Alaska, Bigstone, and other jurisdictions, including best practices

and lessons learned

Regional Health Authorities profiles•

the concepts of an Ombudsperson and a Charter of Rights for •

First Nations Health

legal analysis of existing legislation and a strategy for achieving •

legislative change to benefit BC First Nations, and a legal analysis

of new legislation to create the holistic First Nations health

governance structure

business plans and an analysis of the sustainability of the First •

Nations health governance structure

an overall map of how the holistic First Nations health •

governance structure will work

Planning will begin amongst the FNHC and iFNHA for the •

implementation of a holistic First Nations health governance

structure model that built on a legislative foundation, and that

ensures that any non-profit or corporate entities are ultimately

accountable to BC First Nations, and are subject to the transparency

and accountability standards established by BC First Nations.


Regional Offices

First Nations have agreed-upon the need for Regional Offices that •

will serve as the central repository and main contact for information

within the region, and provide technical support for the work of the

Regions pursuant to the Consensus Paper 2011, Consensus Paper

2012, Framework Agreement, and Regional Partnership Accords

A Regional Offices implementation plan will be prepared by the •

FNHC and iFNHA; this plan will describe a cost-effective approach

to and timeframes for creating Regional (and Sub-Regional as

appropriate) Offices and vesting those Regional Offices with

responsibilities for community engagement and technical work of

the Regions

Upholding Our Commitments

The Engagement & Approval Pathway will continue to be employed •

by the FNHC, FNHDA and FNHA (including the interim FNHA)

to obtain First Nations feedback and direction on strategic-level

decisions with respect to the First Nations health governance

structures

In addition to the Engagement & Approval Pathway, regular •

engagement, two-way reporting, and communications take place,

and will continue to take place, at various forums and through a

variety of media, including: Regional and Sub-Regional Caucus

meetings; Gathering Wisdom for a Shared Journey forums; annual


reports; quarterly infobulletins; monthly FNHC meeting summary

letters; website and social media; articles; and, other mechanisms

The FNHC will develop an annual Community Engagement Plan that •

will bring consistency and focus to engagement by defining annual

engagement and communications priorities and milestones, and

establishing a schedule of Regional Caucus and other meetings each

year

The iFNHA will schedule annual comprehensive reports to each •

Regional Caucus session from the Board of Directors and on progress

in Health Actions


Summary of Consensus

The content of this Consensus Paper is a direct result of the feedback

provided by BC First Nations in the Navigating the Currents of Change

Workbook, which was presented at regional and sub-regional caucus

meetings hosted between January and March 2012.

Board of Directors Governance Structure

In total, 80% of the Workbook participants preferred Regional

Representation because it provides for stronger regional voice to support

decision-making processes; and further, regional representation gives

a sense of ownership and trust in the First Nations Health Authority.

Although they recognized that a larger Board could pose a challenge

for reaching consensus and recruitment efforts, First Nations provided

feedback and determined that:

The Board of Directors of the FNHA will be regionally-representative;•


Staggered terms must be put into place to ensure smooth •

transitions, appropriate orientation, continuity, and corporate

memory;

A rigorous orientation process for new Board members is required, •

to ensure they are culturally-competent and fully familiar with their

legal and fiduciary obligations as Board members;

Mentorship materials be developed to generate awareness of Board •

responsibilities, and increase the capacity of BC First Nations to

participate on the Board of the FNHA; and

An Elder advisor position for the Board of the FNHA should be •

established

Board processes must be cost-effective•

The separation of business and political functions must be upheld, •

and conflict of interest avoided

First Nations also reviewed a set of competency standards for leadership

of the FNHA and provided a number of comments:

BC First Nations individuals are highly preferred;•


A high degree of cultural competency and knowledge of BC First •

Nations communities, including rural, remote, urban, and other

issues facing First Nations should be held by all Board members;

Leaders must be healthy themselves; and•

The FNHC should have competencies adopted too.•

First Nations Health Governance Structure Model

First Nations reviewed four different types of models – a non-profit

model, a corporate model, a legislative model, and a hybrid model. The

two models which received the most support were the hybrid model

(33%) and the legislative model (30%). But overall, they indicated a

strong preference for a holistic governance model which:

Embodies First Nations philosophies, holistic approaches to health •

and wellness (including medicine wheel);

Understands that First Nations community engagement is the •

foundation for the process;

Blends the best of available non-profit, corporate, and legislative •

models;


Pursues opportunities to amend existing legislation to better meet •

our needs, and develop new legislation to recognize the unique

holistic First Nations health governance model;

Ensures that any legislation is carefully considered and planned;•

Is underpinned by legislation that describes how any subsidiary •

elements are accountable to First Nations through the FNHA as the

overarching legislated structure;

Results in improved services and access to First Nations; •

Meets the 7 Directives; and•

Is consistent with applicable legislation – such as the Canada Health •

Act.

First Nations indicated the need for further research to inform the First

Nations health governance model, including:

Other examples of First Nations health governance models in Alaska, •

Bigstone, and other jurisdictions, including best practices and lessons

learned;

Regional Health Authorities profiles – how they operate and are •

structured;


Dispute resolution and the concept of an Ombudsperson;•

The concept of a Charter of Rights for First Nations Health;•

Legal analysis of existing legislation and changes to legislation that •

would benefit First Nations;

Legal analysis of new legislation to create the holistic First Nations •

health governance structure;

Business plans and an analysis of the sustainability and cost-benefit •

approach of the First Nations health governance structure; and

An overall map of how the holistic First Nations health governance •

structure will work.

Regional Offices

74% percent of the participants supported the concept of a Regional

Office. They liked the idea of a ‘closer to home’ model where

communities can network, gather, receive services and referrals, and

meet with health personnel and representatives. There was some

concern about the cost of regional offices and creating yet another

bureaucracy and top-heavy process.


Additional Feedback

The following feedback on community engagement and

communications represents a general consensus of opinions from the

workbooks:

Enhance communication materials keeping in mind the needs of •

primary audience (e.g. readability, accessibility, FAQ’s; limit the use of

jargon and acronyms);

Enhance timeliness, frequency and consistency of the •

communications;

Improve consistency in scheduling of meetings, and keep the focus •

on moving the process forward;

Enhance communications outreach by developing and circulating an •

orientation package for newly elected Chiefs;

Support communities to develop Community Health and Wellness •

Plans (e.g. community health plan templates);

Enhance communication about the Community Engagement Hub •

alignment;

Enhance linkages with off-reserve and urban people;•

Look at health equity between urban and rural communities;•


Learn from the past (mistakes and promising practices);•

Provide clarity and enhance linkages and working relationships •

between Hubs, Regional Caucuses and health directors; and

There was equally mixed messaging that the process was either •

moving too fast or too slow – but all agreed that a clear plan and

process is required so people understand the process, like the process

and trust the process and its leadership.


Appendix FNHC Resolution Adoption of Consensus Paper May 2012

RESOLUTION #2012-01

FIRST NATIONS HEALTH COUNCIL CHIEFS IN ASSEMBLYGATHERING WISDOM FOR A SHARED JOURNEY V MAY 16, 2012VANCOUVER, BC

SUBJECT: ADOPTION OF CONSENSUS PAPER 2012: NAVIGATING THE CURRENTS OF CHANGE – TRANSITIONING TO A NEW FIRST NATIONS HEALTH GOVERNANCE STRUCTURE

WHEREAS

A. In 2005, the First Nations Leadership Council, Government of Canada, and Province of British Columbia signed the Transformative Change Accord, committing to establish: a new relationship based on mutual respect and recognition; and, 10-‐year plans to bridge the differences in socio-‐economic outcomes between First Nations and other British Columbians particularly in the areas of education, housing, economic opportunities, and health.

B. In 2006, the Transformative Change Accord: First Nations Health Plan (TCA: FNHP) was reached between the First Nations Leadership Council and the Province of British Columbia. This plan described a series of actions to improve First Nations health over a 10-‐year period. At the same time, a First Nations Health Plan Memorandum of Understanding (“MoU”) was signed by the First Nations Leadership Council, Government of Canada, and Province of British Columbia; this MoU demonstrated Canada’s support for the TCA: FNHP and committed the Parties to negotiate a tripartite First Nations health plan. These agreements were supported by resolutions (FNS 0307.07 and UBCIC 2007-‐06).

C. In 2007, the Tripartite First Nations Health Plan (TFNHP) was signed by the First Nations Leadership Council, Government of Canada, and Province of British Columbia. This 10-‐year plan supported the health actions set out in the TCA: FNHP and established commitments to create a new structure for the governance of First Nations health services in British Columbia including: a First Nations Health Council to provide political First Nations

Page 1 of 6

leadership; a First Nations Health Authority to manage First Nations health programs and services currently administered by the federal government ; and, a First Nations Health Directors Association to support capacity development, training and knowledge transfer.

D. In 2008, a regional caucus process was established to inform and obtain feedback from BC First Nations on the implementation of the health governance commitments of the TFNHP; regional caucus meetings were held across the province, open to all 203 BC First Nation communities, and particularly focusing on engagement with each Chief and Senior Health Lead from each First Nation community. This informed the British Columbia Tripartite First Nations Health – Basis for a Framework Agreement on Health Governance (“Basis Agreement”) signed in 2009. The Basis Agreement set out areas of agreement amongst the Parties, and the parameters for the negotiation of further agreements with respect to the establishment of a new First Nation health governance arrangement.

E. Pursuant to the commitments in the Basis Agreement, in April 2011, the First Nations Health Council recommended a draft Tripartite Framework Agreement on First Nation Health Governance (“Framework Agreement”) for approval by First Nations in BC. The Framework Agreement was reviewed in detail at a series of regional, sub-‐regional and other First Nations meetings across BC.

F. From 2008-‐2010, over 90 regional and sub-‐regional caucus sessions were held. All of the feedback from these meetings was rolled up into give regional summary documents and a province-‐wide Consensus Paper 2011: BC First Nations Perspectives on a New Health Governance Arrangement. The Consensus Paper gathered all of the wisdom, feedback and direction provided by First Nations for the establishment of the new First Nations health governance arrangement, including: 7 directives for the establishment and operation of the new health governance arrangement; the mandates and activities of the various entities in the new health governance arrangement – Regional Caucuses and Tables, the First Nations Health Authority, First Nations Health Council, and the First Nations Health Directors Association; the principles and processes of reciprocal accountability for the success of this new health governance arrangement; and, a clear set of next steps for the First Nations Health Council to undertake in the establishment of the new health governance arrangement.

G. On May 26, 2011, First Nations in BC, through a historic level of consensus, passed Resolution 2011-‐01 at Gathering Wisdom for a Shared Journey IV. Through Resolution 2011-‐01, First Nations:

a. Approved the Consensus Paper 2011: BC First Nations Perspectives on a New Health

Governance Arrangement;

Page 2 of 6

b. Approved the Framework Agreement;

c. Directed the First Nations Health Council to develop a workplan for Resolution 2011-‐01 and provide that workplan to Regional Caucuses for comment;

d. Continue to engage and communicate with, and be accountable to, First Nations in BC through a variety of mechanisms and media; and,

e. Hold Gathering Wisdom for a Shared Journey V in May 2012 to report on progress and seek further approvals and direction from First Nations in BC.

H. As per the direction of First Nations in Resolution 2011-‐01, the First Nations Health Council released the Resolution 2011-01 Workplan in the Fall of 2011. This Workplan set out milestones, timeframes, key decision points, and indicators for achieving the direction established by First Nations. The Resolution 2011-‐01 Workplan also established an Engagement & Approval Pathway, a consistent process for First Nations to provide strategic direction for the work of the First Nations Health Council, First Nations Health Authority, and First Nations Health Directors Association moving forward.

I. Consistent with the Engagement & Approval Pathway, in January 2012, the FNHC released the Navigating the Currents of Change: Transitioning to a New First Nations Health Governance Structure Workbook (“Workbook”), and made the Workbook the focus of a series of First Nations regional caucus sessions across the province. The Navigating the Currents of Change Workbook took into account the feedback and direction of First Nations through the more than 200 regional, sub-‐regional and community meetings held to date and presented it to First Nations as the discussion document stage of the Engagement & Approval Pathway. Feedback from the Workbook was developed into a series of give regional summary papers, signifying the engagement summary step of the Pathway. These regional reports were provided to each region for review and discussion and were then merged into a province-‐wide Consensus Paper 2012: Navigating the Currents of Change – Transitioning to a New First Nations Health Governance Structure. This Consensus Paper represents the building consensus step of the Pathway.

J. The Consensus Paper 2012: Navigating the Currents of Change – Transitioning to a New First

Nations Health Governance Structure is being put forward for review and consideration in accordance with the ratiHication step of the Pathway at the 5th Annual Gathering Wisdom for a Shared Journey Forum to be held on May 15-‐17, 2012. Its purpose is to chart a course for the effective management of change and transition to a new First Nations health

Page 3 of 6

governance structure in BC and the achievement of the vision of healthy, self-determining and vibrant BC First Nations children, families, and communities.

THEREFORE BE IT RESOLVED

1. That the Chiefs in Assembly at Gathering Wisdom for a Shared Journey V approve the enclosed Consensus Paper 2012: Navigating the Currents of Change – Transitioning to a New First Nations Health Governance Structure, including the following key elements:

a. Setting the Standards: Afgirming and implementing the d Directives, Corporate Governance Requirements, and Competencies for the Board of Directors of the interim and permanent First Nations Health Authority;

b. Setting the Stages: Ensuring a deliberate and planned approach to the work, in accordance with the key stages of Transition and Transformation;

c. Setting the Structure: Congirming the establishment of a regionally-‐representative Board of Directors, a holistic First Nations health governance model, and Regional /fgices; and,

d. 4pholding /ur Commitments: Afgirming that high standards of Reciprocal Accountability and Engagement are the foundation for our ongoing success.

2. That the Chiefs in Assembly at Gathering Wisdom for a Shared Journey V direct the First Nations Health Council to undertake the following next steps as outlined in, and consistent with, the Consensus Paper 2012: Navigating the Currents of Change – Transitioning to a New First Nations Health Governance Structure:

a. Continue to implement the next steps outlined in the Consensus Paper 2011: BC First

Nations Perspectives on a New Health Governance Arrangement;b. Transition the interim FNHA to the permanent FNHA by implementing a regionally-‐

representative Board of Directors, including: amending the bylaws to reglect a regionally-‐representative model respecting each Nation’s uniqueness; creating a process within six months to support Regions to undertake Board posting, recruitment, evaluation, assessment, and nomination processes for 5 regionally-‐representative Board positions consistent with the competencies referred to in 1(a) above; and, creating mentorship materials for BC First Nations on Board membership, among other things;

c. Develop a rigorous orientation process for FNHA Board members, to ensure that all Board members are culturally-‐competent and fully familiar with their legal and giduciary obligations;

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d. Develop and implement a cost-‐effective plan, selection and evaluation process and role description for a male and female Elder Advisor for the Board of Directors of the iFNHA (and FNHA);

e. Conduct and provide research to BC First Nations for further discussion, development, and strategic decision on a holistic First Nations health governance model, including: other examples of First Nations health governance models; Regional Health Authorities progiles; the concepts of an /mbudsperson and a Charter of Rights for First Nations Health; legal analysis of existing legislative changes to benegit BC First Nations, and of potential new legislation to create the holistic First Nations health governance structure; business and sustainability plans; and, an overall map of how the holistic First Nations health governance structure will work;

f. Begin planning the implementation of a holistic First Nations health governance structure model as described in the Consensus Paper 2012 that is built on a legislative foundation, and that ensures that any non-‐progit or corporate entities are ultimately accountable to BC First Nations, and are subject to the transparency and accountability standards established by BC First Nations;

g. Prepare a Regional /fgices implementation plan to describe a cost-‐effective approach to and timeframes for creating Regional (and Sub-‐Regional as appropriate) /fgices;

h. Employ the Engagement & Approval Pathway to obtain First Nations feedback and direction on strategic-‐level decisions with respect to the First Nations health governance structures;

i. Develop an annual Community Engagement Plan that will degine annual engagement and communications priorities and milestones, and establish a schedule of Regional Caucus and other meetings each year, including an annual iFNHA report including ginances and activities to each Regional Caucus session; and,

j. Undertake an independent evaluation of the First Nations health governance structure, including ginancial management, as depicted in Figure ` of the Consensus Paper 2012 and provide that to BC First Nations Chiefs prior to Gathering Wisdom for a Shared Journey VI.

3. That the Chiefs in Assembly at Gathering Wisdom for a Shared Journey V direct the First Nations Health Council to update and enhance the Resolution 2011-01 Workplan to include the action items set out in this Resolution and Consensus Paper 2012, and provide quarterly updates to BC First Nations on progress in implementing that Workplan.

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4. That the Chiefs in Assembly at Gathering Wisdom for a Shared Journey V direct the First Nations Health Council to, consistent with the Consensus Paper 2011 and the Consensus Paper 2012, continue to engage and share information with, and be accountable to, First Nations through a variety of mechanisms, including but not limited to: Regional Caucuses; Gathering Wisdom for a Shared Journey forums; presentations to other provincial First Nations leadership organizations; annual reports; communiqués; and, online and digital media.

5. That the Chiefs in Assembly at Gathering Wisdom for a Shared Journey V direct the First Nations Health Council, consistent with the commitments described in the Tripartite Framework Agreement on First Nation Health Governance, to hold Gathering Wisdom for a Shared Journey VI in Fall 2013 to report on progress in the implementation of this resolution, and seek further direction and approvals of First Nations Chiefs in BC.

Moved: Chief Charlie Cootes, Uchucklesaht Tribal Government

Seconded: Chief Bill Cranmer, ‘Namgis First Nation

Abstentions: None

Disposition: Carried 148 in favour 10 opposed

Date: May 16, 2012

Endorsed:

___________________________ ___________________________ Grand Chief Doug Kelly Warner AdamChair Deputy Chair

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